Behavioral Health Parity - Pervasive Disparities in Access to In-Network Care Continue 

A landmark report issued by the nonprofit research institute RTI International, Behavioral Health Parity – Pervasive Disparities in Access to In-Network Care Continue, provides new insights about the barriers that people with mental illness encounter when trying to access mental health care. The report found that patients were forced to use out-of-network mental health providers more frequently than patients use medical and surgical treatment, and in-network office visit reimbursement was also 22% higher on average for medical and surgical clinicians than office visits with behavioral clinicians – signaling mental health benefits parity is still far from a reality. The study also found that physician assistants were reimbursed for office visits an average of 19% higher than psychiatrists and 23% higher than psychologists. Reimbursements are the “key levers” that health plans use to encourage in-network participation, the study from nonprofit RTI International said.

“This research demonstrates the profound need for employers and purchasers to demand more of their health insurance carriers to ensure they are providing truly equitable access to behavioral health care in compliance with parity requirements,” Shawn Gremminger, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, said in a statement.

Judge Temporarily Blocks Ohio Ban on Gender-Affirming Care for Trans Youth

A Columbus judge on Tuesday, April 16^th temporarily blocked a controversial bill banning gender-affirming care for transgender youth and prohibiting trans students from participating in athletics on teams that align with their identity.

Judge Michael Holbrook issued a temporary restraining order on House Bill 68, which would have prevented minors from accessing care such as hormone blockers, hormone replacement therapy and some mental health services.

It would have also prohibited trans athletes from taking part in middle and high school sports. The TRO is for two weeks, but it is renewable. The law was expected to go into effect next week.

Earlier in the week, a Joint Committee on state rules declined to invalidate a rule developed by the Ohio Department of Health that would ban gender transition surgeries for youth and referrals for such interventions. 

Several other rules related developed by the departments of Health and Mental Health & Addiction Services were delayed and put into a refiled status.

OhioMHAS Virtual Data Forum — April 24

The Ohio Department of Mental Health and Addiction Services (OhioMHAS) is pleased to announce our next Data Forum on April 24, 2023, from 3:00 p.m. to 4:15 p.m. The purpose of the Data Forums is to:

• highlight new data resources, share information about current and upcoming data projects;
• facilitate opportunities for peer-to-peer learning;
• demonstrate how data can be used in the daily practice of ADAMH Boards and Behavioral Health providers; and
• discuss local needs related to data and data infrastructure.

The Data Forum series will convene on a quarterly basis to provide a venue for sharing timely and useful best practices, examples, and resources for ADAMH Boards and behavioral health providers that may be implementing or updating their own data systems and data analytic capabilities.

Intended Audience

This resource is intended for any stakeholders who are interested in learning about data and data resources, including ADAMH Board and Behavioral Health provider leadership and staff who work with, manage, and communicate data at all levels.

APRIL DATA FORUM AGENDA

1. Peer-to-Peer Learning – Lessons Learned in Utilizing Local Data from Suicide Fatality Review Committee, Dallas Allen, Franklin County Coroner’s Office
2. Peer-to-Peer Learning – Data Sharing and Analysis of Local Behavioral Health Hospital Data, Dr. Anju Mader, MD, Stark County Mental Health & Addiction Recovery
3. New Data Product – Annual Data Brief
4. Update – Data Modernization Project

Click Here to Register

Contact [email protected] if you have any questions. 

Only 8% of Medicaid and 4% of Medicare Enrollees Received Behavioral Health Services

New government findings outlined in a recently issued report add details to the lack of availability of behavioral health services for America’s poor and elderly.

The Office of Inspector General (OIG) for the U.S. Health and Human Services Department found that about one-third of behavioral health providers in selected counties serve patients in the Medicare, Medicare Advantage, or Medicaid programs.

The report focuses behavioral health services offered during 2021 -- a time before significant action was taken by the agency that oversees the three programs, the Centers for Medicare & Medicaid Services (CMS), along with the White House and Congress.

Medicare spends an estimated $27 billion a year on behavioral health services, while about 1-in-4 members are coping with a behavioral health condition. For Medicaid, the cumulative spending totals about $52 billion, while adult members experience mental health conditions at a rate of 29% and substance use disorders (SUD) at about 21%, the report states. Some of the causes of the shortage are well-known in the industry: the administrative burden of participating in certain health plans (especially the prior authorization and credentialing processes), low payment rates by payers and overall provider shortages.